Alterations in Hematological/Immune

Question 1

Erythrocytes

Answer 1

RBCs

Question 2

Leukocytes

Answer 2

WBCs

Question 3

Polycythemia

Answer 3

An abnormally high number of RBCs

Question 4

Thrombocytes

Answer 4

Platelets

Question 5

Clotting Cascade

Answer 5

The series of steps that occur during the formation of a blood clot after injury by activating a cascade of proteins called clotting factors

Question 6

Anemia

Answer 6

Low number of RBCs

Question 7

Hemoglobin

Answer 7

The protein contained in RBCs that is responsible for delivery of oxygen to the tissues

Question 8

Hematocrit

Answer 8

Volume % of RBCs in the blood

Question 9

Pediatric Hematologic Considerations

Answer 9

Production of blood cells begins at ~8 weeks in-utero

Fetus receives iron (Fe) through the placenta from mom

Erythropoietin is derived primarily from the liver in the fetus, kidneys take over after birth

Three types of normal hemoglobin present at birth
- Adult (Hgb A and A2)- present in-utero and predominate around ~2 months after birth
- Hgb F- predominate at 8wks GA, decreases to ~70% by birth & disappears by 6-12 months

Question 10

Iron-Deficiency Anemia

Answer 10

Most common nutritional disorder in the world, prevalence higher in developing countries
- Disproportionally impacts children and pregnant women

Occurs when the body does not have enough Fe to produce Hgb

Question 11

Risk Factors for Iron-Deficiency Anemia

Answer 11

Prematurity or LBW

Exposure to lead

Exclusive breast-feeding beyond 4 months of age w/out Fe supplementation

Cow’s milk without adequate Fe intake

Low socioeconomic status

Recent immigration from developing country

Use of meds that interferes with Fe absorption (antacids)

Question 12

Etiology of Iron-Deficiency Anemia

Answer 12

Dietary lack
Impaired absorption
Increased requirement
Chronic blood loss

Question 13

Diagnostic Criteria for Iron-Deficiency Anemia

Answer 13

For children 6 months to <5 years:
- Ferritin <15 micrograms/Land
- Hemoglobin <11 g/dL (for children 0.5 to 5 years)

For children 5 to <12 years:
- Ferritin <15 micrograms/Land
- Hemoglobin <11.5 g/dL (for children 5 to 12 years

Question 14

Clinical Manifestations of Iron-Deficiency Anemia

Answer 14

Usually no sx in mild cases, can cause growth retardation in prolonged (chronic) cases

Reported symptoms may include: irritability, headache, weakness, shortness of breath, dizziness, pallor and fatigue

Koilonychia: Spoon-shaped dents in nails

Less common sx include: pica, muscle weakness, unsteady gait, difficulty feeding

Question 15

Assessment of Iron-Deficiency Anemia

Answer 15

Inspect mucous membranes and skin for pallor

Assess for spooning of the nails

Auscultate for flow murmur

Assess spleen for splenomegaly

Question 16

Nursing Interventions for Iron-Deficiency Anemia

Answer 16

Goal is to determine and treat underlying cause

Encourage breast-feeding mothers to increase their daily intake of Fe
- If formula-fed encourage Fe fortified formula

Cow’s milk in intake for children >1 year of age should be limited to less than 24oz/day
- Cow’s milk makes it harder for the body to absorb iron
- Prevents digestive tract from absorbing iron from foods

Educate, educate, educate! Collaborative care with caregivers

Avoid NSAIDs, treat aches/pains with Tylenol
- NSAIDS can cause GI bleeding and irritation as well as iron loss

Recommend Fe supplementation for infants beginning at 4 months of age
- ~3-6mg/kg/day of iron supplementation, best to take 1hr before meal to enhance absorption
- Warn caregivers that stools may be black in color
- Constipation may occur: increase fluid intake and fiber, may need stool softener
- Place drops behind teeth (give with straw in older children), as can cause staining

Question 17

Heme Sources of Iron

Answer 17

Beef
Chicken liver
Chicken
Turkey
Crab
Tuna
Halibut
Pork
Shrimp

Question 18

Non-Heme Sources of Iron

Answer 18

Iron-fortified cereals & oatmeals
Soybeans
Lentils
Kidney & lima beans
Black-eyed peas
Navy, black pinto beans
Spinach

Question 19

Sickle Cell Disease